In the 1998 comedy, Something About Mary, Chris Elliot’s character Woogie breaks out in “love blisters” (hives) every time he encounters Mary (Cameron Diaz). Who wouldn’t? But for most folks it’s much harder to predict what will trigger an unpleasant skin reaction—especially when it comes to encounters with personal hygiene products and makeup.

According to a new report in JAMA Internal Medicine online adverse reactions to personal care products are underreported and the industry is under-regulated. Dr. Steve Xu, the study’s lead author, said in Europe they’ve banned 1,000 chemicals from personal care products; in the U.S. only 10 are forbidden.

And an accompanying editorial points out that reigning in the industry is a daunting task: “The Office of Cosmetics and Colors within the FDA…is tiny…even considering its limited

responsibilities and scope of authority.” The FDA cannot order a mandatory recall of a harmful cosmetic! One hair care product had more than 20,000 complaints about “permanent” hair loss to the company; the FDA got concerned in 2014, the FDA after directly receiving 127 consumer reports about WEN by Chaz Dean Cleansing Conditioners. The FDA was surprised the company had 20,000+ reports yet hadn’t told the FDA. 20,000 complaints, and no one told the FDA. And the product is still being sold.

The most common troublemakers (we know about) are hair and skin care products—triggering rashes, hair loss and other dermatological problems, although, the study found, more serious illnesses, such as cancer or severe allergic reactions, were also reported. And the label may be inadequate, to understate it: Many moisturizers promoted as remedies for

skin problems like eczema and labeled as `fragrance-free’ or `hypoallergenic’ may still contain chemicals that can cause irritation, a different recent study from researchers at Northwestern University suggests. Researchers asked Amazon, Target and Walmart to name their top 100 best-selling whole-body moisturizers sold online. Then the researchers assessed how well these popular products moisturized the skin, whether or not their ingredients might trigger allergic reactions.

Only 21, or 12 percent, of the 174 individual products tested were free of allergens, the study found. Roughly 83 percent of moisturizers labeled “hypoallergenic” contained at least one ingredient believed to potentially cause allergic reactions, the study found. And 45 percent of products claiming to be “fragrance free” actually contained a fragrance or a botanical ingredient. Thus, for people with sensitive skin or problems like eczema or psoriasis, however, this study confirms that reading labels may not necessarily guarantee a safe or effective product. Many of the moisturizers contained fragrances and chemicals known as parabens, which can cause rashes and worsen skin conditions like eczema and psoriasis. This means you can’t assume that moisturizers marketed as hypoallergenic, fragrance-free or even dermatologist-recommended will actually help skin conditions.

For moisturizers, white petroleum or pure shea butter are lower risk, but trusting the labels is not enough. Making sure there are as few ingredients as possible is also a good thing to double check. Moisturizers are a great solution for patients with skin disorders because they retain moisture in the skin, reduce inflammation, help prevent infection, are widely available and can be more affordable than prescription skin remedies.

So how can you know if a shampoo, face cream, moisturizer or anti-aging potion is safe for you? Try an at-home patch test before using the product. The researchers suggest putting a small amount on the inside of your forearm—for 24 hours. It’s not an overly sensitive area, so if the product triggers a reaction there, chances are you’re at risk for a true allergic reaction. Thanks for reading. Feel free to send questions—to [email protected]

Dr Mike Roizen

You can follow Dr Roizen on twitter @YoungDrMike (and get updates on the latest and most

Dr. Roizen is Cleveland Clinic’s Chief Wellness Officer and served as first Chair of its Wellness Institute. The Institute’s programs have helped Clinic employees lose 455,000 pounds; reduce smokers from 15.4 to 5.2%; flatten the cost curve, and developed StressFreeNow & other programs that The Institute’s Enterprise share with 40 corporations. He sees patients in Cleveland Clinic’s Wellness Institute in the Premier Program (of Executive Health—the Premeier Program serves more women than men).

He is a Phi Beta Kappa graduate of Williams, AOA from UCSF School of Medicine, certified in Internal Medicine and Anesthesiology, authored 175 peer reviewed publications, & served 16 years on FDA advisory committees.

Dr. Roizen founded twelve companies, including RealAge, co-invented a drug approved by FDA, and published a series of highly popular bestsellers including 4 #1 New York Times bestsellers: translated into 44 languages and ranked #1 in five countries.

He and Dr. Oz write a daily column syndicated to 134 newspapers; hosts a two-hour radio show weekly. He shared a daytime Emmy, an Elle, a lifetime achievement award, and the Paul Rodgers award for best medical communicator from the National Library of Medicine.

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